Domestic Violence

September 1, 2011

Domestic violence, or intimate partner violence, is defined as a pattern of assaultive and coercive behaviors, including physical, sexual, and psychological attacks as well as economic coercion that adults or adolescents use against their intimate partners. Other terms used to describe intimate partner violence include domestic abuse, spouse abuse, courtship violence, battering, marital rape, and date rape. Some professional fields use the term domestic violence to refer to any type of interfamilial violence.

Domestic violence has been widely recognized as an international problem. Worldwide, the United Nations International Children’s Emergency Fund (UNICEF) reports that a quarter to half of women around the world experience some form of violence from an intimate partner over their lifetime. The World Health Organization (WHO) estimates that worldwide, between 10% and 69% of women are physically assaulted by an intimate partner at some time in their lives and that 40-70% of female murder victims are killed by an intimate partner. While there is less information about the frequency of male victims, they are generally considered to be at lesser risk of both victimization and severe injuries from victimization.

It is very difficult to ascertain the number of domestic violence victims because many victims may try to hide their experiences with abuse. Factors that hinder reporting of abuse include a societal stigma of being a victim, fear of retaliation by the perpetrator, fear of lost income, or fear of isolation from family. Because of these barriers, many victims are never identified.

The National Crime Victimization Survey is conducted annually to estimate the incidence of violent victimizations. This survey estimates that there are 960,000 incidents of domestic violence annually, with 85% of the victims being women. This translates to eight in every 1,000 women and one in every 1,000 men aged 12 or over being a victim each year. Another large national survey conducted by the Commonwealth Fund (1999) estimates that 3.9 million women are physically abused each year. Variation in estimates may be due to different samples, different definitions used in surveys, or different questions used to solicit information about abusive events.

Intimate partner violence is a repetitive phenomenon. Nearly a third of female victims reported that they had been victimized at least twice in the previous 6 months. Violence is also considered to be cyclical and often escalating, so that periods without abusive events may be followed by intensified abuse.

Intimate partner violence leads to many shortand long-term adverse health outcomes. About half of women who report being a victim of abuse report that they were physically injured and among victims treated in Emergency Departments approximately a third require hospital admission. Over half of women who are victims experience mental health effects, including depression, anxiety disorder, symptoms of posttraumatic stress disorder, and suicide attempts. Victims are also at high risk for stress-related physical conditions, such as gastrointestinal disorders and chronic pain syndromes. Abuse has been linked to pregnancy complications such as low weight gain, anemia, and infections as well as to adverse pregnancy outcomes such as premature labor and low infant birthweight.

Economic costs related to intimate partner violence are high. The annual cost for direct medical treatment of battered women is estimated at approximately 1.8 billion. The total costs of intimate partner violence as a crime are estimated at $67 billion.

Although there is no specific profile for a domestic violence victim, there are several risk factors that have been identified consistently in the existing research. These include young age of the victim and/or partner, low income and educational status, low self-esteem, isolation, and experiences with violence as a child.

Similarly, perpetrators of domestic violence share some common characteristics. Among the strongest predictors of abusive behavior is witnessing domestic abuse in the childhood home. This research suggests that abuse is largely a learned behavior and that abusive patterns begin in childhood. Personality characteristics such as insecurity, low self-esteem, controlling behavior, extreme jealousy, aggressive personalities, borderline personality, narcissistic behavior, and antisocial personality disorders have also been linked to abusive behavior.

Societies that have marked gender inequality and rigid gender roles, which support a man’s right to inflict violence and which do not have strong sanctions against violence, render women particularly vulnerable. Women are also less likely to report abuse and seek help in such societies.

Prevention of abuse largely focuses on identification and support for victims, legal reform, and treatment programs for perpetrators. Clinical screening of abuse in Emergency Departments and clinics has helped identify victims and has increased referral to support systems. It is important for clinicians to recognize that victims of abuse may present with stories that are inconsistent with their diagnoses. Many women try to hide their abuse, in some cases because the abusive partner is with them during treatment. An inconsistent story, especially when accompanied by old injuries, is an indicator of abuse. Victims may also present to clinicians with nonspecific symptoms. Because many of the physical consequences of abuse are stress related, clinicians should routinely screen for abuse when treating these conditions.

Several states have mandatory reporting laws for health care providers, although these laws are controversial. Women’s crisis centers and battered women’s shelters are important components of prevention. These centers offer such services as protected and anonymous shelter, job training, counseling, and assistance with legal matters.

Legal reforms include better definitions of domestic violence in the court system and more rigorous prosecution and sentencing. Victimless prosecution is one example. In victimless prosecution, the state can prosecute the perpetrator in the absence of a formal victim complaint so that the victim does not need to be the primary accuser. This approach was enacted because many women recanted their reports of abuse to police because of fear of retaliation or fear of losing financial support for themselves and their children. Most police jurisdictions have implemented training to better prepare police officers to recognize and respond to domestic disputes. Some jurisdictions have also implemented mandatory arrest at the scene and this is thought to reduce physical consequences from violent events. Wider use of restraining orders has been implemented throughout the United States, although evaluations of their use have shown various levels of effectiveness.

Treatment programs for batterers offer an avenue for perpetrators to understand and reduce their abusive behaviors. Group counseling is the most common approach and programs focus on discussion of gender roles, communication skills, and skills to solve problems. When men voluntarily seek help and actively participate in such programs they are thought to be effective. However, many men who attend these programs do so based on a court order or by referral and often do not complete the program.

There is great need for evaluation of prevention measures to determine which are most appropriate for victims and which are most successful at reducing violent events.

United States Department of Justice. (1998). Violence by intimates: Analysis of data on crimes by current or former spouses, boyfriends, and girlfriends. (NCJ-167237). Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics Factbook.